Provider Demographics
NPI:1629164074
Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Entity Type:Organization
Organization Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Other - Org Name:HACKENSACK MERIDIAN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-751-3713
Mailing Address - Street 1:1340 CAMPUS PARKWAY
Mailing Address - Street 2:SUITE A3
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-751-3750
Mailing Address - Fax:732-751-3751
Practice Address - Street 1:1340 CAMPUS PARKWAY SUITE A3
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-751-3750
Practice Address - Fax:732-751-3751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22440251G00000X
NJ22747251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1027553OtherAETNA
NJ1077948OtherHORIZON NJ HEALTHCARE MER
NJ206864OtherUNIFORM FAMILY HEALTH SER
NJ2K0104OtherHEALTHNET ROUTINE
NJ311533OtherEMPIRE BLUE CROSS BLUE SH
NJ311533OtherUNITED HEALTHCARE
NJIL8654OtherHEALTHNET INPATIENT AND R
NJ311533OtherAMERICHOICE
NJ311533BOtherFIRST HEALTH
NJA896553OtherOXFORD
NJ311533OtherDEVON
NJ40682OtherAMERIGROUP
NJ311533OtherHORIZON BLUE CROSS BLUE S
NJ311533BOtherPHCS
NJ7860200Medicaid
NJIL8654OtherHEALTHNET INPATIENT AND R
NJ311533OtherUNITED HEALTHCARE